Publications

Abstract

In May 2007, Yale University sent a team of nurse practitioner faculty and students to Managua, Nicaragua, as part of a five-year project to provide health care for children who attended a small school in a poor area of the city. Over the course of four days, 88 children were examined and treated. Although the Ministry of Health of Nicaragua theoretically provides health care for all, resources are often limited and difficult to access. By working with teachers and families, the team from Yale University is attempting to help the community establish a school-based clinic to meet the day-to-day needs of the children and establish health care contacts for more serious health care needs.

Abstract

The objective of this study was to describe the cultural domain of ethical behaviours in clinical practice as defined by health care providers in Mexico. Structured interviews were carried out with 500 health professionals employed at the Mexican Institute of Social Security in Mexico City. The Smith Salience Index was used to evaluate the relevance of concepts gathered from the free listings of the interviewees. Cluster analysis and factor analysis facilitated construction of the conceptual categories, which the authors refer to as 'dimensions of ethical practice'. Six dimensions emerged from the analysis to define the qualities that comprise ethical clinical practice for Mexican health care providers: overall quality of clinical performance; working conditions that favour quality of care; use of ethical considerations as prerequisites for any health care intervention; values favouring teamwork in the health professional-patient relationship; patient satisfaction scores; and communication between health care providers and patients. The findings suggest that improved working conditions and management practices that promote the values identified by the study's participants would help to improve quality of care.

Abstract

This study assessed factors that contribute to exercise in older adults at risk for health disparities living in a predominantly African American urban community. A local health database was used to gain an understanding of these factors, which then could be used to develop programs to improve health within a specific urban community. The sample included 112 participants (mean age = 81); the majority were women and African American. Participants were more likely to exercise if not insured by Medicaid, compared with those who did receive Medicaid. Adults with two or more limitations in instrumental activities of daily living (IADLs) were less likely to exercise. Among those who exercised, those with two or more limitations in IADLs were more likely to exercise less than adults with no such limitations, and adults with high blood pressure were more likely to exercise less than those without high blood pressure. The findings of this study will help generate discussion in both the community and outreach programs to invigorate exercise among older adults at risk for health disparities.

Abstract

Individuals with a history of injecting drugs are at the highest risk of becoming infected with the hepatitis C virus (HCV), with studies of patients in methadone maintenance treatment programmes (MMTPs) reporting that 60-90 percent of intravenous drug users (IDUs) have the virus. Fortunately, HCV therapy has been shown to be effective in 42-82 percent of all patients with chronic HCV infection, including IDUs. While the decision to start HCV therapy requires significant consideration, little research exists that explores the attitudes of drug users toward HCV therapy. Therefore, this paper examines how drug users perceive the treatment, as well as the processes by which HCV-positive individuals examined the advantages and disadvantages of starting the HCV medications. Interviews were conducted with 164 patients from 14 drug treatment programmes throughout the United States, and both uninfected and HCV-positive drug users described a pipeline of communication among their peers that conveys largely negative messages about the medications that are available to treat HCV. Although many of the HCV-positive individuals said that these messages heightened their anxiety about the side effects and difficulties of treatment, some patients said that their peers helped them to consider, initiate HCV treatment or both. Gaining a better understanding of drug users' perceptions of HCV treatment is important, because so many of them, particularly IDUs, are already infected with HCV and may benefit from support in addressing their HCV treatment needs. In addition, currently uninfected drug users will likely remain at high risk for contracting HCV and may need to make decisions about whether or not to start the HCV medical regimen in the future.

Abstract

This study examines predictors of Western physician utilization using the Andersen's Behavioral Model of Health Services Use for Chinese elders who reside in Shanghai and immigrant Chinese elders who reside in the US Chinese elders are under-studied relative to their population size and in the US are known to underutilize the healthcare system. Underutilization is highly correlated with poor health and well-being. A unique dataset allowed us to examine predictors of physician utilization for Chinese elders who resided in different countries, in an effort to determine how being an immigrant affects utilization. One hundred and seventy-seven Chinese elders in Boston and 420 Chinese elders in Shanghai participated in the survey. Multiple regression analyses were conducted separately for each sample. Predictors of physician visits for the Boston sample are insurance status, health, and social network, and for the Shanghai sample, use of Chinese medicine, health, and marital status predicted physician visits. We found that access to care variables significantly affects physician utilization for immigrant elders, and that Chinese elders in Shanghai utilize a bicultural system of care. The results indicate that in order to create effective healthcare practices for elder Chinese, alternative healthcare beliefs should be understood by Western physicians.

Abstract

This chapter presents the results of two related exploratory, qualitative studies on drug use and HIV risk conducted in the cities of Managua and Chinandega, Nicaragua between 2002 and 2005. The objectives of this research were to: identify methods of reaching drug using populations in the country; provide an initial description of the patterns of drug use, emphasizing regional differences; explore the relationship between drug use and HIV transmission; and provide preliminary recommendations for the development of drug use and HIV prevention efforts and for future research directions. The study designs included ethnographic observation and interviews to assist in gaining entry into drug-using communities, in-depth interviews with drug users and traffickers (121) and focus groups (13) with sectors of the population likely to provide different perspectives on the research domains: health professionals working with high-risk behavior groups, female sex workers, gay men, university students, taxi drivers, injection drug users, and family members of drug users. Drug use, the availability of drugs and distribution were reported, and included: ubiquitous drug supplies; the involvement of all social strata; the impact of crack on drug-use patterns; concerns about use by children and youth; well-established local distribution mechanisms; group drug purchase and sharing, and (limited) needle use and equipment sharing. Sexual risks included unprotected sex with partners and sex for drugs and/or drug money. The lack of drug prevention education in the community and schools, and limited treatment resources were also reported. Conclusions highlight the need for public and policy acknowledgement and response regarding drug use, and the link between HIV/AIDS and drugs in the country.

Abstract

Problem: Factors that predict successful transition from pediatric to adult care for adolescents with sickle cell disease are not fully understood, making transfer decisions difficult. Methods: Seventy-four adolescents (14-21 years) participated in this descriptive correlational study to investigate the relationships of age, gender, knowledge about sickle cell disease, disease severity, and family relationships to independence. Findings: Knowledge, severity, and family relationships explained only 25% of the variance for independence in the final model; family relationships were inversely correlated. Conclusions: Factors exerting stronger influences on independence remain unknown. Cultural factors may be important among this predominantly African American population.

Abstract

This study examined gender differences in factors related to contributory behavior among the oldest-old aged 80+ in Shanghai, China. The study population included a randomly selected sample of 349 community dwelling respondents who lived in five districts. Male and female respondents contributed equally to others in informal networks, but in different ways. Objective health status and social ties are related to contributory behavior for both males and females. However, financial status and vision impairment had a different impact on males and females. Healthy aging and strong social networks are two key components for contributory behaviors.

Abstract

We previously demonstrated the role of a phospholipid transfer protein (PLTP) gene variation (rs2294213) in determining levels of high-density lipoprotein cholesterol (HDL-C) in hypoalphalipoproteinemia (HypoA). We have now explored the role of PLTP in hyperalphalipoproteinemia (HyperA). The human PLTP gene was screened for sequence anomalies by DNA melting in 107 subjects with HyperA. The association with plasma lipoprotein levels was evaluated. We detected 7 sequence variations: 1 previously reported variation (rs2294213) and 5 novel mutations including 1 missense mutation (L106F). The PLTP activity was unchanged in the p.L106F mutation. The frequency of the rs2294213 minor allele was markedly increased in the HyperA group (7.0%) in comparison with a control group (4.3%) and the hypoalphalipoproteinemia group (2.2%). Moreover, rs2294213 was strongly associated with HDL-C levels. Linear regression models predict that possession of the rs2294213 minor allele increases HDL-C independent of triglycerides. These findings extend the association of rs2294213 with HDL-C levels into the extremes of the HDL distribution.

Abstract

Note 48 Concepts and tools in genetics and genomics 48 Introduction 48 Genes and chromosomes 49 Gene expression and protein synthesis - regulation of gene expression 49 DNA and human diversity 51 Complex, multifactorial disorders 53 Approaches used to conduct genetic studies 53 Expression analyses: RNA-based studies 57 Proteome analyses: protein-based studies 59 The new frontier: systems biology 60 Research-related issues unique to the study of pain alleles 60 Genetics and pain sensitivity 60 The complexities of determining genetic risk factors for chronic pain 60 Pharmacogenetics and analgesic drugs 61 Molecular biologic tools in the elucidation of pain mechanisms and drug discovery 63 References 63 The genetics of pain is a complex trait, due to a combination of genetic and environmental factors.

Abstract

Objective: To describe grandparenthood status and determine the relationship between grandparenthood status, metabolic control, and psychosocial factors in African American women with type 2 diabetes. Methods: A secondary, descriptive, exploratory analysis was conducted to examine the relationship between grandparenting status, physiologic indices related to metabolic control (body mass index, hemoglobin A1c, systolic blood pressure, low-density lipoprotein cholesterol) and psychosocial factors (emotional distress and quality of life) in a sample of 109 urban midlife African American women with type 2 diabetes. Results: Grandmothers made up 60% of the sample and were stratified into three groups on the basis of caretaking status. Grandmothers who cared for but did not live with grandchildren had the highest body mass index, hemoglobin A1c, low-density lipoprotein cholesterol, and systolic blood pressure. Caregiving grandmothers also had higher diabetes-related emotional distress scores but had better quality of life scores than did the non-caretaking grandmothers. Non-grandmothers had the lowest quality of life scores. Conclusions: These findings suggest relationships between grandmother caretaking status and metabolic and psychosocial factors. Research is needed to further examine these relationships and implications on practice and policy decisions.

Abstract

Background and Aims: Hepatitis B virus (HBV) infection is significantly higher in Asian American Pacific Islanders (AAPIs) than in the general U.S. population. People chronically infected with HBV not only have the potential for developing cirrhosis and primary hepatocellular carcinoma, but also are potential sources for infecting others. Therefore, early diagnosis of HBV infection can reduce the risk of further transmission of the virus through education and vaccination of high-risk groups. The aim of this study was to screen for current and past HBV infection in this high-risk group. Methods. A community-based participatory study was conducted between 2004 and 2007. A total of 609 Korean Americans (KA) completed HBV blood screening tests in seven Korean churches in Colorado. Current HBV infection (HBsAg), past HBV infection (anti-HBc positive), and HBV susceptibility were measured. Demographic Information, including HBV vaccination history on these groups, was obtained. Results. Korean Americans had an almost ten times higher incidence of current (4%) and past HBV infection (41%) than the general U.S population. Older individuals had a higher incidence of past HBV infection and lower immunization rate. The risk of lifetime HBV infection was less among participants younger than 30 (OR: 0.07; 95% CI: 0.02-0.21) and those who self-reported HBV vaccination (OR: 0.12; 95% CI: 0.05-0.29). Variables associated with immunity due to vaccination (anti-HBc negative but positive to anti-HBs) were, age under 30 (OR: 13.86, 95% CI: 4.68-41.05), and self-reported vaccination (OR: 8.06; 95% CI: 3.43-18.92). Conclusions. Our study findings confirm the high prevalence of HBV infection among AAPIs, specifically among AAPIs in regions where AAPIs constitute a small proportion of residents. Given the high incidence of HBV infection among these community-dwelling KA, and that the majority of HBV-infected participants were unaware of their condition, focused HBV screening should be conducted to uncover individuals with HBV.

Abstract

Background. Vaginal infections are common and have been associated with increased risk for acquisition of human immunodeficiency virus type 1 (HIV-1). Methods. We conducted a randomized trial of directly observed oral treatment administered monthly to reduce vaginal infections among Kenyan women at risk for HIV-1 acquisition. A trial intervention of 2 g of metronidazole plus 150 mg of fluconazole was compared with metronidazole placebo plus fluconazole placebo. The primary end points were bacterial vaginosis (BV), vaginal candidiasis, trichomoniasis vaginalis (hereafter, "trichomoniasis"), and colonization with Lactobacillus organisms. Results. Of 310 HIV-1-seronegative female sex workers enrolled (155 per arm), 303 were included in the primary end points analysis. A median of 12 follow-up visits per subject were recorded in both study arms (P = .8). Compared with control subjects, women receiving the intervention had fewer episodes of BV (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.49-0.63) and more frequent vaginal colonization with any Lactobacillus species (HR, 1.47; 95% CI, 1.19 -1.80) and H2O 2-producing Lactobacillus species (HR, 1.63; 95% CI, 1.16 -2.27). The incidences of vaginal candidiasis (HR, 0.84; 95% CI, 0.67-1.04) and trichomoniasis (HR, 0.55; 95% CI, 0.27-1.12) among treated women were less than those among control subjects, but the differences were not statistically significant. Conclusions. Periodic presumptive treatment reduced the incidence of BV and promoted colonization with normal vaginal flora. Vaginal health interventions have the potential to provide simple, female-controlled approaches for reducing the risk of HIV-1 acquisition.

Abstract

The long-term care (LTC) literature has been generally associated with industrialized countries. However, LTC needs are increasing in the developing world at a rate that far exceeds than experienced by industrialized countries. Using China as a case study, the purpose of this report is to provide an example of an emerging institutional care system for rural elders in a rapidly developing country. It covers two major domains of the system: service delivery and financing. The report presents several main issues involved in the development of institutional care for elders and discusses relevant policy implications.

Abstract

Purpose: To determine the (a) levels of acculturation and job satisfaction, (b) relationship between acculturation and job satisfaction, and (c) effects of select sociodemographic variables in predicting job satisfaction among Filipino RNs educated in the Philippines who are working in the US. Design: Descriptive correlational. A convenience sample of Filipino RNs (N=96) present during the PNAA Eastern Regional Conference in Baltimore, MD was conducted. Methods: A survey was conducted using A Short Acculturation Scale for Filipino Americans (ASASFA) to measure acculturation, Part B of the Index of Work Satisfaction Scale (IWS) to assess job satisfaction, and a participant demographic questionnaire. Data were analyzed using A Pearson correlation coefficient and multiple regression analysis. Findings: Participants had a moderate level of job satisfaction that was positively correlated to a level of acculturation that was closer to American than to Filipino culture. Furthermore, age, length of U.S. residency, and acculturation significantly predicted perception of job satisfaction among this group of Filipino RNs. Conclusions: Job satisfaction among Filipino nurses is related to acculturation and select sociodemographic variables. Further research to determine how best to improve acculturation may lead to improved retention rates of Filipino nurses in countries to which they have migrated. Journal of Nursing Scholarship, 2008; 40:1, 46-51.